Provider Demographics
NPI:1396010526
Name:DASARI, VIVEKANANDA (MD)
Entity type:Individual
Prefix:
First Name:VIVEKANANDA
Middle Name:
Last Name:DASARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 HAWKINS RUN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-6638
Mailing Address - Country:US
Mailing Address - Phone:972-546-5660
Mailing Address - Fax:469-672-6733
Practice Address - Street 1:340 HAWKINS RUN RD STE 200
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-6638
Practice Address - Country:US
Practice Address - Phone:972-546-5660
Practice Address - Fax:469-672-6733
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2223208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics